Tropical sprue
Tropical sprue is a condition that occurs in people who live in or visit tropical areas for extended periods of time. It impairs nutrients from being absorbed from the intestines.
Tropical sprue (TS) is a syndrome characterized by acute or chronic diarrhea, weight loss, and malabsorption of nutrients.
Malabsorption
Malabsorption involves problems with the body's ability to take in (absorb) nutrients from food.
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Causes
This disease is caused by damage to the lining of the small intestine. It comes from having too much of certain types of bacteria in the intestines.
Risk factors are:
- Living in the tropics
- Long periods of travel to tropical destinations
Symptoms
Symptoms include:
- Abdominal cramps
Abdominal cramps
Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.
ImageRead Article Now Book Mark Article - Diarrhea, worse on a high-fat diet
- Excess gas (flatus)
Excess gas (flatus)
Gas is air in the intestine that is passed through the rectum. Air that moves from the digestive tract through the mouth is called belching. Gas is ...
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- Fever
- Leg swelling
- Weight loss
Weight loss
Unexplained weight loss is a decrease in body weight, when you did not try to lose the weight on your own. Many people gain and lose weight. Uninten...
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Symptoms may not appear for up to 10 years after leaving the tropics.
Exams and Tests
There is no clear marker or test that clearly diagnoses this problem.
Certain tests help to confirm that poor absorption of nutrients is present:
- D-xylose test to see how well the intestines absorb a simple sugar
- Tests of the stool to see if fat is absorbed correctly
- Blood tests to measure iron, folate, vitamin B12, or vitamin D
Vitamin B12
The vitamin B12 level is a blood test that measures how much vitamin B12 is in your blood.
Read Article Now Book Mark Article - Complete blood count (CBC)
Complete blood count
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
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Tests that examine the small intestine may include:
- Enteroscopy
Enteroscopy
Enteroscopy is a procedure used to examine the small intestine (small bowel).
ImageRead Article Now Book Mark Article - Upper endoscopy
Upper endoscopy
Endoscopy is a way of looking inside the body using a flexible tube that has a small camera and light on the end of it. This instrument is called an...
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- Upper GI series
Upper GI series
An upper GI and small bowel series is a set of x-rays taken to examine the esophagus, stomach, and small intestine. Barium enema is a related test th...
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Treatment
Treatment begins with plenty of fluids and electrolytes. Replacement of folate, iron, vitamin B12, and other nutrients may also be needed. Antibiotic therapy with tetracycline or trimethoprim with sulfamethoxazole is typically given for 3 to 6 months.
In most cases, oral tetracycline is not prescribed for children until after all the permanent teeth have come in. This medicine can permanently discolor teeth that are still forming. However, other antibiotics can be used.
Outlook (Prognosis)
The outcome is good with treatment.
Possible Complications
Vitamin and mineral deficiencies are common.
In children, sprue leads to:
- Delay in the maturing of bones (skeletal maturation)
- Growth failure
When to Contact a Medical Professional
Contact your health care provider if:
- Tropical sprue symptoms get worse or do not improve with treatment.
- You develop new symptoms.
- You have diarrhea or other symptoms of this disorder for a long period of time, especially after spending time in the tropics.
Prevention
Other than avoiding living in or traveling to tropical climates, there is no known prevention for tropical sprue.
Reviewed By
Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Ramakrishna BS. Tropical diarrhea and malabsorption. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 108.
Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 126.